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Asthma treatment: emergency action plan
If your child has asthma you need an emergency action plan, regardless of how mild or severe the symptoms usually are.
Severe asthma attack
Here's what to do if your child has a severe asthma attack:
- Remain calm and sit your child down.
- For children aged 0-5 years, give 2-6 separate puffs from the inhaler (usually the blue one) through the spacer. For each puff of medication, your child should take four deep breaths before you give the next puff.
- For children aged six years or older, give 4-12 separate puffs from the inhaler. For each puff of medication, your child should take four deep breaths before you give the next puff.
- Wait four minutes. If there's little or no improvement, repeat step 2 or 3 above.
- If there's still little or no improvement after four minutes, call an ambulance and state that your child is having an asthma attack. While waiting for the ambulance to arrive, give your child puffs from the inhaler through the spacer as described above. Wait four minutes and do it again. Repeat this until the ambulance arrives.
An asthma flare-up is when your child has mild asthma symptoms like coughing, wheezing or mild breathlessness. If your child is experiencing these symptoms, here's what you should do.
- Remain calm and sit your child down.
- Give your child 2-4 separate puffs from the inhaler (usually the blue one) through the spacer. For each puff of medication, your child should take four deep breaths through the spacer before you give the next puff.
- Wait four minutes. If symptoms haven't improved, repeat steps 1-3.
- If symptoms continue, call an ambulance and state that your child is having an asthma attack.
- If symptoms have improved, keep watching your child throughout the day for further flare-ups. If symptoms happen again, repeat steps 1-3.
Clinical categories of asthma
Children with asthma can be grouped into three clinical categories:
- infrequent intermittent asthma
- frequent intermittent asthma
- persistent asthma.
Your child's asthma treatment and management plan depends on which category she's in.
Infrequent intermittent asthma
With this kind of asthma, symptoms happen several times a year, usually in association with a cold or other viral infection. If your child has infrequent intermittent asthma, he might wheeze or cough for a few days when he's having a flare-up and should respond rapidly to treatment.
If your child has infrequent intermittent asthma, between asthma attacks or flare-ups she's usually in good health and leads a normal, active life with no asthma symptoms.
Children with infrequent intermittent asthma usually need treatment only for an acute asthma attack. They usually don't need to take any asthma medications in between attacks. Most children with asthma fall into this group.
Frequent intermittent asthma
Children with frequent intermittent asthma have several acute attacks each year, at least every six weeks.
If your child has frequent intermittent asthma, he might have an intermittent cough, or a wheeze triggered by exercise.
Some children with frequent intermittent asthma might be need to take preventer medication on a daily basis to prevent acute attacks.
This is the smallest group of children with asthma. If your child has persistent asthma, she has symptoms at least once a week. Her symptoms can happen during the day or night.
Children with persistent asthma might need to take several preventer medications each day.
Asthma relievers, preventers and controllers
Asthma medications can be divided into the following categories:
- relievers, which treat and relieve asthma symptoms
- preventers, which prevent acute attacks
- controllers, which are used when asthma is uncontrolled despite the use of relievers and preventers.
Some children take one, two or even three of these types of medications. Your doctor will tell you the most appropriate medications for your child to take.Depending on your child's needs and the severity of his asthma, there are different ways to take asthma medication including inhaling it, taking it in liquid, tablet or powder form, or having injections.
Beta-2 agonists like salbutamol (Ventolin®, Asmol®) and terbutaline (Bricanyl®) are the drugs most commonly used to treat acute asthma symptoms. These drugs help to relax the narrowed airway passages and make it easier for air to get through.
Steroids (prednisolone) are often given early during an acute attack to minimise acute inflammation. This reduces the swelling of the lining of the airway passages.
Drugs to prevent asthma are very important. They either reduce the effects of inflammation in the airways (which is the underlying cause of asthma), or they minimise factors that cause inflammation.
Asthma preventers include:
- inhaled steroids like beclomethasone (Qvar®), budesonide (Pulmicort®), fluticasone (Flixotide®) and ciclesonide (Alvesco®), which children inhale
- steroid tablets or mixtures (prednisolone), which children take by mouth
- sodium cromoglycate (Intal®), which children can inhale and is an alternative to corticosteroids
- montelukast (Singulair®), which is a tablet and another alternative to corticosteroids.
Children who are prescribed preventative medications need to take them every day. Your child should rinse out his mouth after using his steroid inhaler to avoid getting oral thrush.Inhaled steroids taken in normal doses have very few side effects. They have none of the side effects associated with the long-term use of steroids taken by mouth.
If your child's asthma isn't controlled by preventers and your child is more than five years old, your doctor might prescribe symptom controllers.
These drugs are a long-acting version of beta-2 agonists, which means they help to relax the narrowed airway passages and make it easier for air to get through.
Examples include Serevent® (salmeterol) and Foradil® (formoterol). These drugs must be used only in combination with a preventer. Combination inhalers like Seretide® (containing salmeterol and fluticasone), Symbicort® (containing budesonide and formoterol) and Breo Ellipta® (containing flucticasone and vilanterol) make this easier.
Asthma prevention: avoiding triggers
Asthma prevention depends on using preventative asthma medications.
You should also think about factors that might trigger your child's attacks of asthma.
For example, your child should avoid cigarette smoke and being close to animals that cause allergies, including household pets. If your child is affected by goose down or feathers, she might be better off with non-allergenic bedding. In some cases, you might need to remove your carpets to minimise dust and decrease your child's exposure to the common house dust mite.
It's OK to look at how you can balance prevention measures with the need to limit big changes to your family's living conditions. You might not need to make big changes if your child has only mild symptoms.
Understanding asthma management
You and your child need to understand asthma management.
Asthma control and management plans
Every child with asthma should have an individualised asthma control and management plan. This involves you, your child and your doctor:
- knowing what triggers your child's asthma symptoms
- understanding how to take the asthma medication - how much, how often and how to use the inhaler correctly
- knowing what to do if your child's symptoms get worse, and what to do in an emergency if your child doesn't respond to the drugs that he usually takes.
Learning how to use an inhaler is very important. You and your child's health professionals might need to explain and show your child how to do it several times.
It's a good idea for your child to see her doctor or nurse regularly to monitor her asthma symptoms and treatment, and to review the asthma management plan. If you're not sure about any aspects of your child's asthma control and management plan, you should check with your child's health professional.
It's important to let your child's school know about your child's asthma.
Asthma medicines are generally very safe, especially those that are inhaled. Children usually get into trouble because they don't take enough asthma medication, rather than because they take too much.
If you think your child is experiencing side effects from medications, discuss this with your doctor.
Living with asthma
Most children with asthma lead perfectly normal lives.
Keep encouraging your child to do sport and exercise. Your child might benefit from taking his reliever medication just before exercise to prevent a wheeze or a cough from happening.
If your child has frequent attacks, or if symptoms stop her from playing sport, sleeping at night or feeling healthy, it's likely that she's being undertreated or not taking her medication. Talk to your doctor about this so the treatment can be changed if necessary.Children with asthma aren't always good at judging the severity of their symptoms - they often say they feel fine even if their asthma is poorly controlled. Keep an eye on your child's symptoms and visit your doctor if you ever have any concerns.